This month’s Essentially MIDIRS includes an article by Lorna Davies which considers the modern day rise of the terms ‘clinical complexity’ and ‘comorbidity’ within maternity care. Below you can read a short excerpt from the article…
Clinical complexity: the Emperor’s new clothes? by Lorna Davies.
‘Dealing with complexity is an inefficient and unnecessary waste of time, attention and mental energy. There is never any justification for things being complex when they could be simple…’
Within the broad field of medicine, the term ‘clinical complexity’ has latterly become a much cited concept. Like so many catchphrases that are adopted, there is no single universal definition of what ‘clinical complexity’ actually means, although it seems to be generally accepted as an acknowledgement that there is increasing occurrence of chronic diseases and comorbid conditions in the population, which is leading to more complex clinical needs.
Some writers include socio-cultural factors within the definition of clinical complexity whilst others refer to health economics in terms of the increased cost demands on the health service (Bayliss-McCulloch 2007). The term ‘clinical complexity’ has filtered into maternity service jargon where it seems to be used more and more frequently but without any clearly defined context. This led me to explore for myself what ‘clinical complexity’ really means within the jurisdiction of childbirth.
It would make sense, within the holistically framed philosophy of midwifery, that the focus should be broad and should encompass the multifarious components that form women’s lives. These components include social, cultural, emotional and spiritual aspects as well as physical well-being. However, within maternity care, the emphasis would seem to be much narrower than this and is very much focused on the physical changes in women’s health, and the need to manage this change with increasing levels of interventions and, in particular, increasing rates of caesarean section.
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